Is There An Affordable Doctor In The House? / VIEW FROM THE RIGHT

Adam Sparks, Special to SF Gate

Published
4:00 am PDT, Tuesday, July 22, 2003

"The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty, and we must rise with the occasion. As our case is new, so we must think anew and act anew." -- Abraham Lincoln

My dad, the sole breadwinner in the family, was a union baker. During the 1950s, I was raised in a tenement in New York's Spanish Harlem, and my dad made union scale, which was $4.35 an hour at the time. Even so, we could afford a doctor who made house calls every time my sister or I would have mumps, measles or even a nasty fever.

I remember one visit, when my mom, while offering the doctor tea and homemade pastries, tried to convince him that her Old World, European homeopathic remedies were superior. The doc, fed up with Mom's persistence, retorted by telling her to temporarily hold off on the advice until her medical diploma was hanging on the wall behind her.

Today, house visits are now a part of a quaint, bygone era, as is affordable health care, and, shortly, even basic access to doctors will soon lie in the dustbin of history. What happened, and what can be done to restore sanity in health care?

The health-care system is in crisis -- a major crisis. It's our 800-pound gorilla careening about in our living room. The problem is, we're just trying to ignore it with the hope that it'll do no damage and leave on its own. Democrats tend to favor a single-payer system, which will be both a financial disaster and a health-care-delivery catastrophe for our nation, and Republicans simply wish the issue would go away on its own. Both positions are equally untenable and will surely bring on the apocalypse just as quickly. Three current crises are ticking time bombs:

Medicare: The government program's uncontainable expenses are exploding astronomically.

Unaffordability: The rising costs of medical-insurance plans for the insured leave many people on the verge of becoming uninsured.

All these calamities are wreaking havoc and creating stress.

Employers are the primary source of health insurance in the United States, covering 120 million people. But the government is the single most powerful health-care consumer, as it provides coverage to a large number of Americans both as an employer (39.2 million federal, state and local government employees, including the military) and through public insurance programs such as Medicare (39 million) and Medicaid (41 million).

Employees, consumers and taxpayers pay for the rising costs of health care. Businesses pass along a portion of rising premiums to their workforces in the form of lower wage increases. Companies add the cost of the fringe benefits, including health insurance, to the price of their products and services. And government programs pay 47 percent of the health-care tab in the United States; spending on health care makes up 20 percent of the federal budget, and most state budgets, too. If you paid $5,000 in taxes last year, about $1,000 went to health-care programs. And that figure doesn't include surcharges embedded in prices of products.

In the absence of health-care reform, health-insurance premiums will continue to rise rapidly. A report issued by the National Coalition on Health Care (NCHC) finds that the average insurance premiums for a family will to go up to $14,565 per year by 2006. That's more than $5,000 higher than today's average of an already astronomical $9,160.

Furthermore, this projected premium increase alone would force about 10 million Americans, who don't have employers who pay their insurance premiums, to discontinue their coverage, and approximately 42 million Americans are already without insurance.

In approaching solutions, there's a threshold question that first needs to be asked and answered: Do we have a moral obligation to provide health care to everyone as needed, or is health care merely a commodity that should be subject to the same marketplace forces as other commodities?

The question is a bit misleading. It's possible that we can develop a market-based system that is both affordable and provides a solution to everyone's needs. We need a system that's not run by HMOs, politicians, bureaucrats, lobbyists, drug companies or doctors, but is patient driven. We need to give patients more access and better choices at lower rates by restoring simplicity and transparency into the system.

The Solutions Are Many

For starters, get more doctors into medical schools. We need to build more medical schools and train more doctors. Tens of thousands of eminently qualified pre-med students never become doctors because of a lack of space in the universities. The increased supply of doctors would help lower costs, particularly with our aging population. Also, get more nurse-practitioners to take on more of the routine, defined tasks doctors now perform.

The Heartland Institute, a nonpartisan think tank, recently issued a report that offers a more detailed road map to saving our health-care system. Some of the report's highlights include:

Congress should enact a federal income-tax credit for health-care expenses. Consumers cannot deduct health care expenses, but companies can when paying the health care costs for their employees. That's unfair.

Congress should encourage individuals and families to create tax-favored medical savings accounts (MSAs). Tax-deductible MSAs are now available under federal tax law for the self-employed and for employees in firms with no more than 50 employees. MSAs are usually coupled with a relatively inexpensive high-deductible major medical-insurance policy. Individuals and families can use funds deposited in an MSA to pay for such routine expenses as physical examinations, immunizations, vision care, prescription drugs, dental work and other medical costs incurred before the insurance policy's annual deductible is reached.

Congress should enact legislation to create a national legal framework for individuals and families to enroll in association health plans (AHPs) and individual-membership-association plans. AHPs are health-insurance plans created for associations of small businesses in a number of states. They would be regulated for financial solvency and truthful representation under one federal law, instead of the diverse benefit-laden insurance laws of the several states, an inefficient system that drives costs up. Each plan would offer various coverage choices to members.

Congress should pay health-care providers the full cost of services provided to Medicare patients. Cost accounting for health-care services is admittedly complicated and involves numerous arbitrary cost allocations. However, it is widely acknowledged that both Medicare and Medicaid reimbursements to providers are well below the market cost of services rendered. This underpayment requires providers to shift costs to patients who have private-sector insurance.

Congress should enact medical-malpractice reform. Soaring malpractice-judgment awards have seriously raised the costs of medical care (especially for obstetrics and gynecology) and insurance-premium costs in many states, and have even driven professionals out of medicine.

States should roll back costly health-insurance mandates. Currently, the 50 states enforce more than 1,500 mandates on insurance policies, covering such matters as pregnancy, mental-health parity, substance abuse and acupuncture. Consumers ought to be allowed to buy low-cost basic policies and add riders for additional coverage, just as they do with auto insurance.

States should allow the sale of low-cost basic-coverage insurance policies that do not include cost-inflating mandates. Low-cost, mandate-free policies should at least be available to lower-income workers and families who lack employer-sponsored insurance, increasing the likelihood that they will be covered for catastrophic medical events.

States should create high-risk pools, now in operation in 28 states, that serve people with chronic high-cost medical conditions who have been rejected by insurers as uninsurable or who have been quoted premiums far beyond their capacity to pay.

States should repeal certificate-of-need (CON) programs, which regulate expansion of medical facilities. The CON process, enacted to prevent costly duplication of facilities, has rarely, if ever, achieved that result. Maintaining a competitive market requires easy access to competitors who believe they can offer health care more efficiently and satisfactorily than existing providers do.

States and local governments should support community health centers. Such clinics, with local community support and partially staffed by volunteer medical professionals, can play an important role in preventive care and treatment of nonacute medical problems for people not enrolled in Medicaid or in transition between jobs.

Access to medicine is as important to Americans as access to food and shelter is. Yet, it's only in medicine that we see the heavy hand of government in every aspect of the supply and distribution of our system. A web of burdensome federal and state laws, coupled with unnecessary duplication and cumbersome accounting rules, has helped hike the costs of health care. It's not coincidental that it's health care, the nation's most heavily regulated industry, that's on the verge of collapse. Americans are getting housed and fed with minimum government intervention. Why not apply those free-market principles to the delivery of our health-care system?

Yes, the health care system is ill. It needs to be treated in intensive care. The solution is not a government takeover of the system, as some left-wing Democrats are still demanding. The government delivers few services efficiently. But competition has brought down costs to the consumer in every industry it has been introduced to, from long distance-calling to air travel.

The government needs simply to limit its role to paving the way for true competition and free-market reforms and then get out of the way. Finally, it must also compassionately assist those who still fall between the cracks. Anything else will make us all ill. We need simplicity restored. Simple things are nature's best antidotes.